Print and Mail Membership Form
Transcript of Print and Mail Membership Form
A.B.A.T.E. of Kansas, Inc. Membership ApplicationReturn Application to A.B.A.T.E. of Kansas, Inc.
P.O. Box 102, Perry, KS 66073
Date __________________
Dist# _________________
q New Member $30 q Couple $50 q Renewal Ind/Cpl Mbr#_____________________________ q Life Member $300 q Change of Address q Change of District q Registered Voter
Please Print Clearly
Full Name _____________________________________________________________________________________________
Full Name _____________________________________________________________________________________________
Address / Apt#______________________________________________________ County _____________________________
City _______________________________________________ State ______________________ Zip __________________
E-Mail ___________________________________________________________ Phone______________________________
Newsletter: q Mail q E-Mail Referred By _______________________________________________________________
Applicant’s Signature _____________________________________________________________________________________
Payment Type: q Cash q Check Amount $____________ Check #___________ Revised April 2017
A.B
.A.T
.E. o
f Kan
sas,
Inc.
P.O
. Box
102
, Per
ry, K
S 66
073
(785
) 597
-514
0 (
800)
657
-576
3
Date ______________________________Exp ______________________________
q R
enew
al q
New
q C
oupl
e q
Life
q B
usin
ess B
ronz
e q
Bus
ines
s Silv
er
q B
usin
ess G
old
App
lican
t ___
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Rece
ived
By _
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Rece
ipt f
or a
pplic
ant
Fees
are
not
tax
dedu
ctib
le.
q Business Bronze $60 q Business Silver $150 q Business Gold $350q Business Renewal
Business Name______________________________ Point of Contact_______________________________
Place remainder of Business info on reverse side of form.
Business Membership Benefits Outside of all other Member Benefits.
Business Membership Bronze: Small advertisement listing in newsletter.
Business Membership Silver: Small advertisement in newsletter, small listing in Rally Flier, and listing on both A.B.A.T.E. Facebook page and website.
Business Membership Gold: Business Card advertisement in newsletter, small listing in Rally Flier, and listing on both A.B.A.T.E. Facebook page and website.
Note: Small listing will consist of Business Name, Address, Phone, Point of Contact and if they support A.B.A.T.E. members with a discount or other perk.
Couples Membership must be same household.